Akarsh came to visit the Raichur clinic from his home village. He lost his foot 18 years ago in a motor vehicle accident. His current Symes prosthesis (ankle disarticulation)  is 3 years old and he is very happy with it.

Akarsh came to the clinic to have the leather holding the d-loops replaced before it wore though completely. When asked to look at his prosthesis to offer any suggestions for improvements we were very surprised by the design of the socket which left the front section completely open. We checked Akarsh’s skin and found no abrasions or sores. Hardly what we would expect for a farmer working in the field all day on his feet. This is a typical example of what we have seen here, unconventional designs that work very well for the patient!

Following Akarsh’s visit we took the opportunity to explore alternative Symes designs. We discussed  the rationale and fabrication of a medial (side)  obturator door for a Symes prostheses with the workshop technicians. They  are excited to try this new method out and already have a client in mind.

Meet Himmat, a very cute and personable little gentleman. We met Himmat and his mom at the early intervention centre in Koppal. He is 9 months old and has Spina Bifida which led to a surgery following birth and paralysis of both his legs. His mom and current physiotherapist have been working very closely with him to maintain his range of motion and correct alignment in his ankles, knees and hips as he continues to grow. Himmat charmed Yvonne and myself as he smiled and watched us give his big eyes during the physical assessment. In our assessment we found that Himmat had a funky alignment with limited knee flexion and excessive rotation of the hips. Such pudgy babies like Himmat, can often squirm their ways out of braces no matter how tightly the brace straps are pulled. While considering this and after discussing with Himmat’s mom and physiotherapist, we decided that a supracondylar AFO with a removable boot-and-bar system would allow maintain his lower limbs in a more optimal alignment and help make sure the brace stays on. The braces were a success and his mom was happy with the result. We hope that the braces continue to help this little fellow, and when he grows out of them in a few months…guess we will come back to India for a follow up!

Jayesh travelled by bus for 2 hours from her small village to come to see the Samuha Samartha’s technical staff. Because she had travelled so far and had made an appointment, she became a priority in the shop, which frequently has people stopping by unannounced.  Although Jayesh was made felt like a priority, she had taken a day off from her work as a school teacher to see if changes could be made to her calliper (KAFO) in order to decrease the chronic knee pain she has been feeling. Jayesh has used a calliper on her left leg ever since she had been diagnosed as an infant with polio. She is currently 32 years old and received a surgery a year ago to correct a 30 degree knee contracture she developed on her left leg. The X-rays that were taken a year ago of her knee showed signs of arthritis.

With her friendly attitude and passion for education, Jayesh was a great candidate to use to demonstrate how a patient assessment can help guide a clinical decision towards which orthoses can be made. From the patient assessment we found that Jayesh could not get to the full knee extension range that her current calliper was designed for, performed at a grade 2 score for both dorsiflexion and hip flexion, and her main gait deviation was drop foot. Based on her presentation and the current well maintained state of her calliper, our group discussion concluded that this was an appropriate orthoses. To help with knee pain, the upper thigh shell was rotated 10 degrees in order to match the patient’s range of motion. Two additional straps were used to distribute the force away from the knee cage, which was aggravating Jayesh’s knee pain. Before leaving the workshop Jayesh was told about the importance of keeping an eye on a callus that was discovered during the physical assessment, as well as the importance of stretching her hamstrings to make sure her surgery doesn’t go to waste. Jayesh was excited to leave with her modified calliper to see if the new position of her knee and new straps would decrease her pain.

Dainy is a smiley, 7-year old girl. She has an older brother and sister. Dainy has difficulty holding up her head and sitting because her cerebral palsy affects her muscle tone and balance. Dainy has been wearing leg braces (AFOs) for several years so she can practice standing upright in her standing frame, but sitting has always been a problem. Today she received her bright green seating system. This gives her a secure base of support so she can use her arms for playing with her toys and hands-free sitting. Secured in her seat with support straps, Dainy is able to sit nice and straight. Her chair has caster wheels so it can be moved around the tiled floor in her house and at school, and the tray swings away to so it is easy to correctly align her torso.  Her parents are also happy because she can sit independently now for eating and for school work. Do you see the elephant in the chair? Look closely! Dainy is looking forward to getting some of her own stickers to really make this her special chair.

Mahdi is a 24-year old male who suffered from a spinal cord injury while driving his rickshaw 4 years ago. After he was discharged from hospital, he spent most of his time bedridden in his family’s village house because he didn’t have a wheelchair, and he couldn’t afford physiotherapy. In December, Mahdi  joined 4 other men with spinal cord injurries for a 1-month rehabilitation camp at Samuha. His mother also joined him so she could learn about how to support her son at home. Over the 5-weeks the men participated in yoga classes, exercise therapy sessions, adaptive recreational sports, and guest speakers came in to discuss nutrition, vocational opportunities, cooking classes and other recreational sports. Mahdi was the first one to get long-leg braces (bilateral KAFOs). This created much excitement amongst the patients as Mahdi  was able to walk and stand for the first time in 4 years! What a great moment! This helped motivate the others to continue to work hard on their strength and range of motion exercises. Mahdi s mother was so happy because she had seen her son slip into a depressed and hopeless state at home. She noticed that since arriving at Samuha, Mahdi  was back to his normal jovial self, excited about his new mobility and starting to think about how he could live his life differently. The collaboration between Mahdi , his family, the community- based rehabilitation workers, workshop technicians, and volunteers (physios & orthotists) helped to improve his physical strength and fine tune his mobility with the KAFOs for independent walking.